Oral contraceptives: Singaporean gynaecologists share the side effects, effectiveness, and benefits of going on birth control pills
Kid you not
Chances are, you've heard of oral contraceptives. Sure, it might not be a hot-button topic on in our conservative home, but it is a highly contentious one in certain parts of the world — particularly so since the roll-out of Trump's contraception rule, which allows employers to refuse to cover workers' birth control by citing religious or moral objections. As it turns out, there is more to oral contraceptives than pregnancy prevention. Not only does it serve as a symbol of free will and equality, it also grants women the opportunity to make informed choices about their sexual health.
While there is no ban on oral contraceptives in Singapore, it is hardly addressed even in 2019 — leaving us brimming with more questions than ever. How do they work, for instance? What are the types available? How effective are they, really? We speak to local gynecologists to get to the bottom of this.
What are oral contraceptives?
They are essentially a type of birth control taken orally by women, that which alters the menstrual cycle to eliminate ovulation. This prevents pregnancy with a 99% success rate if the pill is used correctly — aka consumed on a daily basis at the same time each day. They are also known to regulate menstruation and reduce heavy menstrual flow.
How do oral contraceptives work?
"There are many brands of oral contraceptives with different preparations and formulations. However, the two main constituents are the female hormones Estrogen and Progesterone." Dr Janice Tung, Associate Consultant of the Department of Obstetrics and Gynaecology in Thomson Fertility Centre, elaborates, "When taken regularly, higher levels of these hormones are maintained in the body, which suppresses other hormonal production from the brain that is responsible for egg maturation and ovulation. As such, ovulation and pregnancy is thus prevented. In many ladies, the pill is stopped for a short duration every month to allow the hormone levels to fall, and menstruation to occur."
How effective are oral contraceptives?
They are highly effective — but only when used correctly, of course. "Oral contraceptives have a failure rate of <1%, provided no pills are missed," says Dr Liana Koe, Obstetrician and Gynaecologist at STO+G Practice, Thomson Medical Centre.
There are, however, exceptions. Dr Tung adds, "Perfect usage is not possible for all women, so actual failure rates may be higher, and up to 9 out of a 100 women on the pill may fall pregnant. Some medications and herbs such as certain antibiotics and St John's wort may also reduce the efficacy of oral contraceptives. As such, dual methods of contraception such as the pill together with condoms is often recommended. Condoms also have the added benefit of reducing the risk of sexually transmitted infections."
Are there any long-term and short-term side effects from taking oral contraceptives?
According to Dr Koe, long-term effects are serious but rare. "They include a higher risk of blood clots in the veins, usually of the legs (known as venous thromboembolism). However, this risk is still less than the chance of venous thromboembolism in pregnancy, and is extremely rare. It only affects about 5-12 per 10,000 women per year. The risk reduces after the first year of use, so long-term use is not a concern. There is also a marginal increase in the risk of breast cancer, though it does reduce over time after stopping the pill and returns to normal after 10 years.
There is also a very small increase in risk of heart attacks and stroke (this affects 1-2 per 10 000 women), and is extremely rare in users of the pill. This risk reduces to normal after stopping the pill as well. In view of this small increase in risk, the pill is not recommended to women at high risk of developing heart diseases or stroke. Overall, though, the pill is very safe and effective, if given to the right group of people. It can be safely used even up to the age of 50 years, if there are no medical reasons to stop the pill."
Are there any medical benefits that come with taking oral contraceptives?
"Yes! Most women are worried about the side effects, but are unaware of the benefits," Dr Koe points out. "There is actually a lowering of risk when it comes to cancer of the womb and ovary, especially if the pill is taken for long periods. The risk decreases with each year of use, up to almost 50% for both if used for up to 10 years. The benefit stays on even after stopping the pill. The risk of colon cancer is also reduced by about 20% in women who have used the pill. In addition, ongoing use allows women to have lighter and less painful periods. Some oral contraceptives are also used to reduce acne, which can be beneficial for some women."
Are oral contraceptives suitable for all women out there?
Unfortunately not. "Women with a tendency towards migraine attacks would not be suitable for taking oral contraceptives," Dr Tung reports. "Those with a history of liver problems, or epilepsy who are on certain types of anti-epileptic medications would also not be suitable. In general, oral contraceptives are better for young women who are looking for shorter-term family planning and not likely to forget pills, or who may also wish to regulate their menstruation."
What are some alternatives to oral contraceptives?
Besides the pill, there are other hormonal and non-hormonal methods out there. Dr Koe finds that women looking for a longer-term prevention of pregnancy may benefit from an intrauterine contraceptive device (IUCD), or the implant, which lasts five and three years respectively. They also eliminate the chance of forgetting a pill.
"Other alternatives include three monthly hormone injectables, or combined hormones in different forms as with a weekly patch. All these forms of contraception are reliable, and effective in preventing pregnancy," says Dr Koe. "And of course, there are condoms, which are the least effective (due to human error), but will reduce the risks of sexually transmitted infections."
Will you experience problems conceiving if you've been on oral contraceptives?
No. Medical research indicates that oral contraceptives have no bearing on fertility rate, though those who suffered from irregular periods prior to going on the pill will likely lapse back into old patterns.